Hospitals use technology to cut ER wait times

Time — as in hours spent writhing in pain, drawing labored breaths or trying to soothe a fevered child — is the latest front in the competitive battle among area hospitals.

Given the notoriously long waits in the nation's emergency rooms, some local hospitals are now advertising that they post average emergency wait times online, or offer to text estimates to patients.

Others tout a system to "schedule" a visit to an ER or urgent care facility. Still another approach is to offer a service to help find a doctor that day in a particular ZIP code.

To be sure, wait times are not being reduced with the mobile apps, text messages or phone calls, but patients may feel more in control, because they learn before they head to a hospital or clinic that doctors are delayed. They then can try a different place, or wait more comfortably at home until minutes — instead of hours — before they'll be treated.

"Unfortunately, it's the world we live in where people use the emergency department as primary care," said Christy Dempsey, senior vice president for operational and clinical consulting at Press Ganey Associates, Inc., an Indiana-based consulting firm to hospitals. "It doesn't surprise me that they may want to schedule (a visit). ... Information is power and it's a good thing to have to make a decision on which (emergency department) to go to."

While not exactly a sea change in doctor-patient relations, these efforts are seen as a ripple in the direction of improving how people rank their experiences with medical providers. That's increasingly important to hospitals in light of satisfaction surveys and ratings reports under new health care regulations. And it may even steer new business their way.

With the average wait time in an emergency department in 2009 at four hours, seven minutes, according to Press Ganey, the potential for dissatisfaction is real.

The cost of lost time in wages has been estimated at billions per year, and the cost in frustration is incalculable, experts say. It's something other industries also are acknowledging. Recently, a major cable company began advertising a guarantee to show up for service calls within a two-hour window, instead of the previous four — a big nod to busy lives and the fact that customers will look elsewhere if they're unhappy.

At least one doctor in the U.S. has been sued by a patient who waited three hours before leaving without the immunization he needed for a next-day overseas trip. The Nevada man sued, saying he wanted to teach the doctor a lesson. He was awarded $250 in small claims court, according to news reports.

And it's no joke that doctors have been presented "bills" for keeping patients waiting, said Vishal Mehta, an orthopedic surgeon with offices in Elgin, Naperville and Geneva who in 2010 launched an interactive system to text delays to patients. He uses MedWaitTime throughout the day, mindful that he may have nuclear physicists from Fermilab among those waiting to see him.

"There are surgeons with God complexes," Mehta said. "But it's rude and a burden on society" to waste people's time.

Being concerned about how long a patient waits is "a piece of caring," Mehta said. "I have to be respectful of the whole experience, not just the 10 minutes I spend with the patient."

Dempsey said overcrowded ERs have been a concern for a while, and hospitals have been urged to tackle the problem by looking at how they function.

"The (emergency department) is as much a front door as the front door," Dempsey said, because of the number of patients admitted through emergency treatment. And while surveys of emergency room experiences are not mandated by federal law, in-patient surveys are — and can be affected negatively by a long wait, she said.

Edward Hospital offers four ways patients can be alerted to wait times for its emergency rooms in Naperville and Plainfield: on its website, via a mobile app, by texting and by phone call, if requested. The times are updated electronically as patients register, said Dr. Tom Scaletta, medical director of emergency services.

If delays spike due to a trauma or complex case, an explanation can be added and an extra team of professionals brought in, a change spurred by an overhaul of services before the hospital began posting wait times, he said.

"You never can predict a day … you can get especially busy for no apparent reason," Scaletta said. "But we wanted to assure patients of a wait time of less than 30 minutes and probably closer to 15."

The service has struck a chord with people, said Cheryl Eck, director of e-health at Edward. When it was launched in September, the mobile app was downloaded 900 times, she said. The hospital issues between 400 and 700 texts per month with wait times.

Edward has drawn business from hospitals that don't post wait times, Scaletta said. Still, he cannot envision going further, such as adopting a system like the one used since February by Provena St. Joseph Hospital in Elgin and Mercy Health System in Janesville, Wis. Called InQuicker, it allows online users to schedule a visit to an ER or urgent care clinic.

"The general concept of a scheduled ER visit is problematic," Scaletta said. "If you're truly an ER, you can't do it that way since, by definition, you take patients in appropriate order according to need."

InQuicker, advertised on a billboard in Elgin featuring a sparkling red Cinderella shoe, allows patients to fill in symptoms, select a projected treatment time and then wait at home. It's not intended for life- or limb-threatening emergencies, but has filters or key words that can indicate to a patient that the situation may demand quicker attention or even to call 911.

"It really more fully meets the need of those who need to be seen," said Barbara Fallon, director of marketing at Provena St. Joseph. "We've gotten great feedback with patients even telling us, 'I could get sicker waiting in the ER.'"

The hospital asks registrants whether they want to be called or emailed if their appointment will be delayed, which can happen if the ER gets slammed. "Sure, it's an investment of time for us to call, but we don't want people to be dissatisfied," Fallon said.

Mercy Health System launched InQuicker at the hospital and several urgent care centers in Janesville, and is evaluating whether to expand to hospitals in Illinois, said Barb Bortner, vice president of marketing and public relations.

In the first three weeks, 175 people used the system, she said, with the vast majority being mothers with children. Bortner unexpectedly used it when her son Jack fell during a basketball game and broke his ankle. She filled out a form online at 5:30 p.m. and took the next appointment 30 minutes later, she said. Any patient with a scheduled time may go ahead of people waiting if their medical issues do not require more immediate treatment, Bortner said.

Mercy does not see the scheduling system as redefining what is an emergency or encouraging patients to come to the ER or urgent care clinic, she said.

"Today's consumer is pretty savvy. If given the choice of the ER versus urgent care, they understand the ER is more expensive," Bortner said.

A similar scheduling system is being implemented in parts of Canada, but for walk-in clinics rather than emergency rooms, said Will Dubreuil, head of business development for Technowait, based near Montreal. The clinics are the middle rung of the three-rung socialized system — emergency rooms for the most severe cases, clinics for relatively minor problems that can't wait, and doctors in offices for routine tests and visits, with appointments often taking weeks.

Under Technowait, a patient takes a number at a clinic in person and gets a call every hour about the projected wait time until it's under 60 minutes, Dubreuil said.

A just-ended one-year pilot program found patients grateful they didn't have to wait the average four hours in a clinic with other sick people, and staff relieved they weren't constantly answering questions about how long the wait would be, he said.

Clinics also reported that patients would drive farther to avail themselves of the service, for which they pay $3 to $5, Dubreuil said.

The technology that is making scheduling and texting wait times possible may end up being used by doctors offices in exciting new ways, Mehta said, such as emailed heath reminders and other information. An example might be a campaign on concussions, where student athletes can watch a video and learn what to do if they suffer certain symptoms.

He also sees text messages as helping his surgical patients, who now can be overwhelmed with instructions on what they should do for up to six months after an operation. Instead, they would get messages at the appropriate intervals, he said.

It's this potential, and not the walk-in or wait time aspects of MedWaitTime, that Brandon Betancourt sees for his wife's pediatrics practice in Algonquin. As business manager, he was approached to include her and the other doctors for a fee. He declined, although Dr. Joanna Betancourt is listed as accepting walk-ins, because he didn't like the idea of posting wait times.

"I don't think patients need to be deciding what doctor to see on the basis of wait times," Brandon Betancourt said.

Yet using the technology to send patients text messages — such as flu shot reminders — would be helpful to them and solidify their relationship to the doctor, he said, adding that he will sign up for that.